Lessons learned: Reflections on M4D Projects

Posted by MelissaUlbricht on Mar 03, 2011

With the increasing number of projects in this mobile-for-change field, there have been a fair share of failures.  We have tried to analyze those with project leaders in our series of FailFaires.

But a project does not need to be a failure to an provide an opportunity for public evaluation, reflection, and dialogue, as we see in a recent series of posts. We were excited to see posts that take an introspective approach: these entries assess program effectiveness, identify gaps in M4D projects, and discuss challenges and solutions in the field.

A post on the Grameen Foundation blog discusses a control trial to asses the impact of a mobile for health project in Uganda:

..We recently completed one of the first randomized control trials designed to assess the impact of a mobile phone-driven health service aimed at improving the lives of the poor.

Preliminary findings from the study are substantial, supporting some of our initial hypotheses and refuting others, and informing our approach to building pro-poor, mobile phone-driven solutions going forward. In short, findings indicated that when people learn of such services, they use them. People also seem to learn from this particular text-message query-based product.  But we also found that, because of the limitations of human motivation and barriers like language and literacy, we have a lot more work to do.

The Health Tips study was conducted in Uganda over an 18-month period. Before the launch of Google SMS in June 2009, IPA conducted a baseline survey of 1,800 people in 60 rural communities, assessing demographic profiles, attitudes, and knowledge and behavior regarding sexual and reproductive health, and collecting data from local clinics.  When we launched the service, we initiated a marketing campaign that randomly targeted half of those communities (the “treatment” areas) and did not reach the other half (the “control” areas)....

We believe that Health Tips is among the most widely used opt-in mobile services targeting the poor.  Though today’s usage falls short of our goals – our ambitions remain much higher for uptake, impact and sustainability – our adoption numbers are still an achievement in a sector where the majority of related projects are still in a pilot phase.  Pundits praise the telecom sector’s ability to bring valuable services to large numbers of people, but other than the mobile money services just beginning to pop up across Africa we don’t know of any mobile phone-related initiatives that are reaching as many people...

Preliminary findings of the study indicate that improvements in knowledge about HIV and contraceptives, the main topics of inquiry, were limited. Findings also clarify that, like many technology tools, the Health Tips service is capable of reinforcing both positive and negative behaviors. Respondents who fit a risk-averse profile (especially women) became both less sexually active and less likely to engage in sex with casual partners. Others who were more prone to risky behaviors in this area were further emboldened, reporting more partners, more unfaithfulness and less use of contraceptives.  It is logical to infer that phones have the potential to reinforce existing tendencies, rather than change behavior, because they make it easier to seek and find information.

Read the complete post here. 

A post on the Grameen Foundation AppLab not only identifies gaps in M4D projects, but suggests ways to overcome them. The gaps include:

  1. In most cases, information and technology alone are not the solution.
  2. Scalability is necessary, but not sufficient, for achieving lasting impact.
  3. Achieving sustainability is HARD.
  4. Insufficient or short-term grant funding.

Read the complete post here.

And, another post from the AppLab Community Knowledge Worker team talks about how information alone is not enough:

 But what became quickly apparent was that information alone is not a complete solution.  A reference pointer or a tip about maternal health techniques may be useful to an expectant mother, but creating deep, impactful behavior change – what information-driven development initiatives seek – requires a context in which that information has a value. People certainly have a hunger for knowledge and a willingness to embrace the mobile phone to search for answers, as shown by all the questions they asked from the beginning about family planning, and HIV and other sexually transmitted infections, which affect them directly and for which few reliable, anonymous sources are available.  But we require several things to make this information actionable and impactful: specific information, a context in which to make it useful, and relevant services and resources.

Read the entire post here.

We welcome this kind of reporting and reflection in an increasingly maturing field that help not only make specific projects better but also help others understand the complexities and challenges of implementing projects in mobile for health. We are also pleased to see more systematic evaluations (with stellar players such as the Poverty Action Lab) and an open discussion about those evaluations.  Kudos to the Grameen Foundation for this inward look!


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